Kienbock's disease.

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Abstract

[Indexed for MEDLINE] 7. J Bone Joint Surg Am. 2025 May 8;107(12):1389-1402. doi: 10.2106/JBJS.24.01090. Kienböck Disease: Recent Advances in Understanding and Management. Lichtman DM(1)(2), Pientka WF 2nd(2). Author information: (1)Department of Surgery, School of Medicine, Uniformed Services University, Bethesda, Maryland. (2)Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, Texas. ➢ An at-risk lunate (due to anatomic factors) subjected to a trigger event (axial load, embolism, hypercoagulability) leads to the development of lunate osteonecrosis.➢ Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention.➢ For disease limited to the lunate, treatment decisions should be driven by the condition of the cartilage; intact lunate cartilage can be treated with joint leveling or core decompression, whereas disrupted cartilage surfaces should be bypassed with scaphocapitate or scaphotrapeziotrapezoid arthrodesis. Newer surgical procedures such as wrist arthroscopy and the introduction of contrast-enhanced magnetic resonance imaging have expanded the treatment options for these patients.➢ Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected.➢ The new unified classification system and treatment are applicable to almost all patients with Kienböck disease. Copyright © 2025 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.24.01090 PMCID: PMC12160086